Special Report on Heel Pain in Children

Heel pain in children is very common. It is often termed "growing pains" and it is more common after a growth spurt. The medical term for this condition is Calcaneal apophysitis, also known as Sever's disease. Although not a true "disease," it is an inflammation of the heel's growth plate due to muscle strain and repetitive stress, especially in those who are active or obese. This condition usually causes pain and tenderness in the back and bottom of the heel when walking, and the heel is painful when touched. It can occur in one or both feet. Diagnosis of Pediatric Heel Pain To diagnose the underlying cause of your child's heel pain, the foot and ankle surgeon will first obtain a thorough medical history and ask questions about recent activities. The surgeon will also examine the child's foot and leg. X-rays are often used to evaluate the condition, and in some cases the surgeon will order a bone scan, a magnetic resonance imaging (MRI) study, or a computerized tomography (CT or CAT) scan. Laboratory testing may also be ordered to help diagnose other less prevalent causes of pediatric heel pain. Treatment Options The treatment selected depends upon the diagnosis and the severity of the pain. For mild heel pain, treatment options include: •Reduced activity. The child needs to reduce or stop any activity that causes pain. •Cushioning the heel. Temporary shoe inserts are useful in softening the impact on the heel when walking, running, and standing. For moderate heel pain, in addition to reducing activity and cushioning the heel, the foot and ankle surgeon may use one or more of these treatment options: •Medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, help reduce pain and inflammation. •Physical therapy. Stretching or physical therapy modalities are sometimes used to promote healing of the inflamed tissue. •Orthotic devices. Custom orthotic devices prescribed by the foot and ankle surgeon help support the foot properly. For severe heel pain, more aggressive treatment options may be necessary, including: •Immobilization. Some patients need to use crutches to avoid all weight-bearing on the affected foot for a while. In some severe cases of pediatric heel pain, the child may be placed in a cast to promote healing while keeping the foot and ankle totally immobile. After immobilization or casting, follow-up care often includes use of custom orthotic devices, physical therapy, or strapping. •Surgery. There are some instances when surgery may be required to lengthen the tendon or correct other problems. Can Pediatric Heel Pain be Prevented? The chances of a child developing heel pain can be reduced by following these recommendations: •Avoid obesity •Choose well-constructed, supportive shoes that are appropriate for the child's activity •Avoid, or limit, wearing cleated athletic shoes •Avoid activity beyond a child's ability If Symptoms Return Often heel pain in children returns after it has been treated because the heel bone is still growing. Recurrence of heel pain may be a sign of the initially diagnosed condition, or it may indicate a different problem. If your child has a repeat bout of heel pain, be sure to make an appointment with your foot and ankle surgeon. Committed to your health, Dr. Craig Conti Sarasota Foot Care Center www.sarasotafootcarecenter.com

Special Report on Achilles Tendon Ruptures

Hello fellow weekend warriors. Today, I am writing about a subject that makes me worry just a little bit. I am 33 years old now and the prospect of an Achilles tendon rupture is all too real. Luckily, I know a few good foot doctors! What is the Achilles Tendon? A tendon is a band of tissue that connects a muscle to a bone. The Achilles tendon runs down the back of the lower leg and connects the calf muscle to the heel bone. Also called the "heel cord," the Achilles tendon facilitates walking by helping to raise the heel off the ground. What is an Achilles Tendon Rupture? An Achilles tendon rupture is a complete or partial tear that occurs when the tendon is stretched beyond its capacity. Forceful jumping or pivoting, or sudden accelerations of running, can overstretch the tendon and cause a tear. An injury to the tendon can also result from falling or tripping. Achilles tendon ruptures are most often seen in "weekend warriors" - typically, middle-aged people participating in sports in their spare time. Less commonly, illness or medications, such as steroids or certain antibiotics, may weaken the tendon and contribute to ruptures. Symptoms A person with a ruptured Achilles tendon may experience one or more of the following: •Sudden pain (which feels like a kick or a stab) in the back of the ankle or calf - often subsiding into a dull ache •A popping or snapping sensation •Swelling on the back of the leg between the heel and the calf •Difficulty walking (especially upstairs or uphill) and difficulty rising up on the toes These symptoms require prompt medical attention to prevent further damage. Until the patient is able to see a doctor, the "R.I.C.E." method should be used. This involves: •Rest. Stay off the injured foot and ankle, since walking can cause pain or further damage. •Ice. Apply a bag of ice covered with a thin towel to reduce swelling and pain. Do not put ice directly against the skin. •Compression. Wrap the foot and ankle in an elastic bandage to prevent further swelling. •Elevation. Keep the leg elevated to reduce the swelling. It should be even with or slightly above heart level. Diagnosis In diagnosing an Achilles tendon rupture, the foot and ankle surgeon will ask questions about how and when the injury occurred and whether the patient has previously injured the tendon or experienced similar symptoms. The surgeon will examine the foot and ankle, feeling for a defect in the tendon that suggests a tear. Range of motion and muscle strength will be evaluated and compared to the uninjured foot and ankle. If the Achilles tendon is ruptured, the patient will have less strength in pushing down (as on a gas pedal) and will have difficulty rising on the toes. The diagnosis of an Achilles tendon rupture is typically straightforward and can be made through this type of examination. In some cases, however, the surgeon may order an MRI or other advanced imaging tests. Treatment Treatment options for an Achilles tendon rupture include surgical and non-surgical approaches. The decision of whether to proceed with surgery or non-surgical treatment is based on the severity of the rupture and the patient's health status and activity level. Non-Surgical Treatment Non-surgical treatment, which is generally associated with a higher rate of re-rupture, is selected for minor ruptures, less active patients, and those with medical conditions that prevent them from undergoing surgery. Non-surgical treatment involves use of a cast, walking boot, or brace to restrict motion and allow the torn tendon to heal. Surgery Surgery offers important potential benefits. Besides decreasing the likelihood of re-rupturing the Achilles tendon, surgery often increases the patient's push-off strength and improves muscle function and movement of the ankle. Various surgical techniques are available to repair the rupture, and the surgeon will select the procedure best suited to the patient. Following surgery, the foot and ankle are initially immobilized in a cast or walking boot. The surgeon will determine when the patient can begin weightbearing. Complications such as incision-healing difficulties, re-rupture of the tendon, or nerve pain can arise after surgery. Physical Therapy Whether an Achilles tendon rupture is treated surgically or non-surgically, physical therapy is an important component of the healing process. Physical therapy involves exercises that strengthen the muscles and improve the range of motion of the foot and ankle. Committed to your health, Dr. Craig Conti Sarasota Foot Care Center www.sarasotafootcarecenter.com

Special Report on Heel Pain

Special Report on Heel Pain Plantar Fasciitis (Heel Pain) Plantar fasciitis is caused by inflammation of the connective tissue that stretches from the base of the toes, across the arch of the foot, to the point at which it inserts into the heel bone. Also called "heel spur syndrome," the condition can usually be successfully treated with conservative measures such as use of anti-inflammatory medications and ice packs, stretching exercises, orthotic devices, and physical therapy. What is the problem? A pain has developed at the bottom of the heel, and it has gotten worse. The patient was not aware of having had any injury that caused it. What does it feel like? It feels like a dull ache most of the time, but when the patient first gets out of the bed in the morning, or when getting up after sitting for a period of time during the day, the pain in the heel is sharp and stabbing. It almost feels like the heel has been bruised, from stepping on a rock barefoot. Testing for Plantar Fasciitis Since there are several causes for heel pain, we need to pin-point the exact location of the pain is in order to diagnose the basic underlying cause for the problem. Testing is simple and generally pain-free. It's important to find out WHERE it hurts, not just HOW MUCH it hurts. After excluding general medical conditions that might cause the condition, the exam is localized to the heel and surrounding structures. The important anatomical structures are the heel bone (calcaneus) and the tissues that attach to the bottom of the heel (plantar fascia). We use X-rays, which allow us to visualize the bones of the foot and make sure there is no fracture of the heel bone. We also use ultrasound, which will allow us to visualize the plantar fascia to determine its thickness and to see if there is any surrounding fluid accumulation or tear. What causes Plantar Fasciitis? There is a tight ligament (band of fibrous tissue) that stretches across the arch, from the ball of the foot to the heel bone, called the Plantar Fascia. When we walk, our feet have a tendency to roll inward, toward each other, in a motion that we call pronation. When feet pronate, they flatten, stretch out and the arch elongates. This causes excessive pulling on the Plantar Fascia ligament and attachment of the ligament to the heel bone begins to separate. An injury occurs where the ligament progressively tears off of the heel, fiber by fiber. Bleeding occurs next to the bone and inflammatory fluids accumulate between the ligament and the bone, forming a Bursitis, or fluid-filled sack. Over time, the body lays down scar tissue, in an attempt to "glue" the detached ligament fibers back on to the bottom of the heel bone. Over the course of 3-5 years, the scar tissue calcifies, and this calcium deposit eventually becomes visible on x-ray as the heel spur. This inflammation of this plantar fascia ligament is called Plantar Fasciitis, and in addition to the bursitis, is what causes the pain. The bone spur itself has no nerve endings and doesn't hurt. It is just an associated finding that tells us that the inflammatory process, the bursitis and plantar fasciitis have been present for a long time. There are several reasons that this chronic injury can occur. Recent weight gain and increased activity level often start an episode. A person who has been mostly sedentary, who suddenly takes up an exercise program of walking or running is a prime candidate. A change of shoes from well supporting walking or athletic shoes to floppy sandals can do it. When the arch of the foot collapses or flattens, the plantar fascia is stretched, causing the injury where it attaches to the heel bone. Finally, conditions which cause generalized increased inflammation, like osteoarthritis or rheumatoid arthritis can cause this. There is one more, smaller category of patients, who have heel pain due solely due to a loss of the protective fat pad cushion on the bottom of the heel. We rely on the heel fat pad, that marvelous structure, to cushion our heel, like the sole of a good running shoe does, from the impact that a modern human body makes when it lands on it. All tissues atrophy or thin as we get older, giving many seniors their "drawn" appearance. The thinned heel fat pad permits bruising, as our body weight is born by a much smaller, bony-hard and more concentrated area. Treatment It is better to rest the heel using common sense. When you are off your feet, the injury is healing and getting better. When you are standing, without any foot support, the heel is getting injured further. When you are standing when wearing orthotics (foot supports) and well supportive shoes, the injury decreases dramatically, but usually is not eliminated altogether. So, during the treatment period, if you have the choice of sitting or standing…sit! If there are no health reasons to avoid them, a few weeks use of an over-the-counter anti-inflammatory medication may eliminate the pain. How does a podiatrist treat Plantar Fasciitis? Treatment for this condition is multifaceted. There are 3 main goals that must be accomplished. First, we decrease the inflammation with anti-inflammatory medications, cortisone shots and ice. Secondly, we begin a course of stretching for the calf muscles. Thirdly, we support the fascia with taping, orthotics and an air heel brace. These measures will eliminate the problem in about 85% of patients within 6-8 weeks. Some get better very quickly while others take the full 8 weeks. How can I prevent it from coming back? Recurrence is possible after treatment but if the patient continues to employ good mechanical foot control by wearing orthotics, stretching and wearing good supportive walking or athletic shoes, chance of recurrence is minimized. If you or someone you love has been experiencing heel pain, the time is NOW to get it evaluated. Delay of care can lead to significant pain and immobility. Don’t let fear keep you away from the treatment you deserve. Committed to you health, Dr. Craig Conti Sarasota Foot Care Center www.sarasotafootcarecenter.com

Special Report on Orthotics

First of all, what are orthotics? Orthotics are custom made devices that fit inside your shoes and improve the function of your feet and ankles. You can think of them as “glasses for your feet.” Just like a pair of glasses causes your eyes to function in the proper way, a pair of orthotics improves the function of your feet and ankles. It also decreases pressure on the bones and skin of the foot, decreases pain and aligns the joints of the foot, ankle and knee.

What aren’t orthotics? Orthotics are not soft, gel or foam things that you can bend with your fingers. For an orthotic to work it must put your foot into a position that your foot does not want to go. During walking, all your weight is on one foot at a time. Imagine all of your weight on a soft, gel or foam device. It will flatten to nothing and will not improve the function of your foot.

Are orthotics comfortable? Absolutely, when they are made properly you don’t even feel them in your shoes. The only way that a pair of orthotics will be strong enough to work and yet comfortable enough that you will actually wear them, is to have them custom molded exactly to your foot.

But what about the ones you can get at the drug store from “the machine” or from the “foot store?” Collectively, the doctors of Sarasota Foot Care Center have been practicing medicine for well over 65 years. Not only do we know how to get you the true orthotic you need, but we will be there to help you down the road if anything happens and adjustments are needed. Try that with the “machine” or the “foot store.”

But aren’t they expensive? Expensive is when you pay good money for something and get no results. We don’t care if the so-called orthotics you can get at the shoe store only cost $60 dollars, they won’t help you. So is $60 dollars for a worthless pad a good deal? I don’t think so.

A pair of custom orthotics will last for about 3-5 years. It will improve your foot function and decrease your pain. Is that worth two installments of $225? How much does your heel hurt? How much would you pay to get out of the bed in the morning without that stabbing, shooting pain? How much would you pay to be able to exercise and finally lose those pounds you need to?

In these very sensitive economic times we completely understand priorities. If the decision is food or orthotics…that is a very simple decision. Another question you have to ask yourself is if you can afford not to get orthotics? Can you afford to miss more work because of your foot pain? Can you afford to take 6 weeks off because of a possibly avoidable surgery? There is not one golfer we know that would not pay that cost to shave a few strokes off of their game. How much easier would tennis be without the pain in the ball of your foot?

What foot conditions do orthotics treat? Orthotics treat a large group of conditions that all stem from the movement of the muscles and bones of the foot. These conditions include, but are not limited to: heel pain, heel spurs, flat feet, “fallen arches,” bunions, neuromas (pinched nerve in the foot), painful corns and calluses under the ball of the foot, sore feet and ankles, tendonitis and joint pain.

What will happen if I need orthotics but I don’t get them, can I do permanent damage to myself? Yes you can. Flat feet are genetic and are usually noticed early in life. If untreated, the excess pressure and abnormal wear and tear on the joints can lead to severe arthritic conditions and loss of function. Heel pain is ultimately a problem with alignment and no amount of stretching or cortisone shots will cure the problem with out addressing the underlying alignment issues. In fact, all the conditions that are treated with orthotics have a major alignment component to them. Leaving this alignment uncorrected only leads to further pain and loss of function. It is critical to correct the root cause of these conditions and the root cause is the deranged alignment. Orthotics are the only thing that can correct this alignment problem.

Will I have to get bigger shoes to fit the orthotics? No, you should not need a larger size to fit your orthotics. Most athletic shoes have a removable foot bed that will create the room needed to fit the orthotics. The same goes for most lace-up loafers or boots. In fact, there are some sandals that have a removable foot bed and work with orthotics as well. There are, of course some shoes that will not work with orthotics. High heels and flip-flops come to mind immediately. Have no fear. If you wear the orthotics when you are most active, occasional flip-flops and high heels are acceptable.

If you have been experiencing pain or soreness in your foot, what are you waiting for? Biomechanical problems, which is to say bone, muscle and joint problems, do not just heal themselves. You would never expect your vision to miraculously improve and you should not ask for miracles with your feet either. If your feet have been hurting you, or you have been watching someone you care about suffer with foot pain, stop waiting and get the pair of orthotics you need, today.


Committed to your health,

Dr. Craig Conti
Sarasota Foot Care Center
www.sarasotafootcarecenter.com

Major Soccer Star Tears Achilles Tendon

British soccer star and frequent tabloid subject, David Beckham, tore his Achilles tendon in a game in Italy this weekend. The footballer will miss all of the World Cup and probably most of the MLS season due to the injury. Becks, as the British press is so fond of calling him, injured the foot in a non-contact aspect of the game. He was just walking around the field when he fell and clutched his heel.
The Achilles tendon is so named after the Greek mythological character who was only vulnerable at the back of his heel. According to the legend, Achilles was dipped in a river by his mother and protected from all harm. Of course his mother had to hold onto some part of young Achilles and allegedly she held him by his heel. Not to spoil the story for you but Achilles is killed by an arrow that hits him right in his heel. What are the chances?
Myth aside, the Achilles tendon has been the downfall of many a great athletic hero. Dan Marino, one of the greatest quarterbacks in football history, had his career ended in a similar non-contact injury. Misty May-Trainor, an Olympic gold medalist in beach volley ball, suffered an Achilles rupture during her time on a television dancing show. What is going on here? These are elite athletes and they are sustaining this major injury while doing basically minimal activity. How is this possible?
The most likely cause is chronic Achilles tendinitis. The Achilles tendon is the biggest, thickest tendon of the body and it allows the calf muscles to point the foot down. This is critical for both running and jumping. Elite athletes and weekend warriors can get a sharp, painful feeling in the back of the heel, especially when getting out of bed in the morning or first getting out of a chair. This pain represents inflammation and tightness at the attachment site of the tendon and the heel bone. If left untreated this tendinitis can weaken the tendon and lead to a rupture.
If you don't want to be added to the list of people with a ruptured Achilles tendon always stretch before you begin strenuous physical activity and see a foot doctor sooner rather than later if you have sharp pain in the back of your heel.

Committed to your health,
Dr. Craig Conti
Sarasota Foot Care Center
http://www.sarasotafootcarecenter.com

One Giant Painful Foot

My worlds collided last week as a New York Giants football fan and as a podiatrist living in Sarasota, Florida. I was watching the game when quarterback, Eli Manning pulled up lame after planting his right heel on a play action pass. My first thought was, "I really hope that was not his Achilles tendon." Luckily for me, and Eli and Giants nation, it was not the Achilles tendon but the plantar fascia that was injured. The plantar fascia is a tight band of connective tissue, basically a blending of many tendons, that goes along the bottom of the foot. Many people, as many as 1 in 4 Americans, will suffer from sharp, shooting pains in the bottom of the heel. Often this pain is worse when you get out of bed in the morning or when you stand up after sitting for a period of time.
The most common cause for this is called plantar fasciitis or inflammation of the plantar fascia. In my office in Sarasota I treat this condition every day. None of my patients are professional quarterbacks who have to plant their feet in order to throw footballs, but it is not a fun condition for a lawyer, waitress or hairdresser either. Typically this condition is treated with anti-inflammatory drugs like Advil, rest, ice, stretching and sometimes a cortisone injection. Taping of the foot or a small foot brace is also used to limit the pain. Long term treatment consists of stretching exercises and use of orthotics, a molded shoe insert that controls foot motion.
Not only do I treat this condition every day, I also suffered from it in my early twenties. I am pain free now due to orthotics and stretching.
I expect to see Eli out on the field on Sunday. First of all because it is amazing what you can do with cortisone, second because the guy just does not quit. Eli has made 82 consecutive starts including the one following a serious shoulder injury. He will start but hopefully the Raiders will allow the Giants to build up a big lead and allow Eli to take a break. I am sure his foot will feel much better if he does.


Committed to your health,

Dr. Craig Conti
Sarasota Foot Care Center
http://www.sarasotafootcarecenter.com

Don't Let Foot Pain Stop Your New Year's Resoloution

Happy New Year! Now is a time of new beginnings. A time when we all look at our lives and try to make things better for next year. It also happens to be the end of the holiday season. A season that, on average, leads to 9 pounds of weight gain due to excessive holiday treats.
One of the most common New Year's resolutions is to lose weight. I know I have made that resolution a few times myself. With 2/3 of the American population overweight, there is a good chance that you, or someone you know will resolve to lose some weight this year. One of the keys to any sensible weight lose program is aerobic exercise. For most of us this means walking, jogging or something of the sort. If you have not been exercising for a while and all of a sudden start a major work out campaign you can cause some serious foot pain. Don't let foot pain stop you from achieving your weight loss goals.
Tendonitis, heel pain and even stress fractures are very common in people who start a new work out program or who have recently increased their activity drastically. Be smart, start off gradually. Remember the story of the tortoise and the hare? Weight loss is a long process. You can't loose all the weight in one really long, hard run. I promise, I have tried it and it does not work. Start with 15 minute increments. You are going to be sore, but there is a big difference between sore and injured. Stretch out before and after you exercise and drink plenty of water to stay hydrated. Make sure you are wearing the proper shoe gear for your activity. You would not start a tennis program without a racket and you should not start a running program without a quality pair of running shoes.
If you have sharp pain in your feet or legs during exercise, stop. Don't try to run through the pain. If you have pain in your feet or legs that is beyond the usual muscle soreness call a podiatrist and have the problem evaluated.
Protect yourself and think long term. Remember, life is a marathon not a sprint! Good luck with your resolutions and I will see you in the gym.

Committed to your health,

Dr. Craig Conti
Sarasota Foot Care Center
http://www.sarasotafootcarecenter.com/